After all the horse-trading and grandstanding that marked the Senate’s health care debate, it’s easy to overlook the historic meaning of the chamber’s December 24 vote. The two houses of Congress have now endorsed the principle that access to decent medical care should be available by right to every citizen. America has finally ratified life as an inalienable human right, alongside liberty and the pursuit of happiness.
To be sure, considerable distance remains between the principle and the reality. The Senate and House versions must still be merged into a single bill that can win approval in both houses, no simple task. Many painful compromises — too many, we believe — have been made already. More compromises will come before the president can sign the reform into law.
In the end, the reform will fall short. Millions will remain uninsured. The right to abortion care will be wrongly curtailed, particularly if the House language prevails. Unionized workers will see hard-won medical benefits threatened if the final bill includes the Senate’s proposed tax on high-quality employer-based coverage.
Most disappointing, private insurers will retain too much leeway for abuse if, as widely expected, the final bill drops the government-run public option included in the House version. The public option is a centerpiece of the reform that progressives anticipated. It’s hardly the single-payer Medicare-for-all plan that progressives wanted. But it would provide competition to the big insurers. And it would embody the principle that medical care is a human right, not a profit center.
Still, as disappointing as the outcome is likely to be, it is to be celebrated. It will be much, much better than what we have now. It will outlaw some of the worst current abuses, including denial of coverage for pre-existing conditions, specious terminations and lifetime caps on covered care. It will not end the obnoxious intrusion of faceless insurance company bureaucrats into the relationship between doctor and patient, but it will put a watchdog over the bureaucrats. And it will cover most of the uninsured.
The critical component of the reform is the creation of so-called exchanges — regulated marketplaces where buyers can choose from a variety of plans that meet defined standards at defined rates, with government subsidies available. If the exchanges attract enough purchasers and are regulated effectively, ideally by Washington rather than the states, big companies will want to take part. Companies that break the rules will be ejected and lose access to the millions of new customers.
The most important reason to celebrate, though, is the simple fact that the principle of universal coverage is being adopted. If the new system proves ineffective, it can be amended, just as Social Security and the income tax have been repeatedly amended. Once the principle is established in law, the question will no longer be whether to provide health care to all, but how well we’re doing it.